Senior Workers’ Compensation Claims Specialist

ViziRecruiter,LLC.; South Carolina; On-site; USD 57,000 - 95,000; Full time

Job summary

AF Group in South Carolina is seeking an intermediate level claim handler to manage workers’ compensation claims with a focus on moderate to difficult cases. You will investigate, determine compensability, and establish reserves within authority, while coordinating with managers on complex matters and potential subrogation opportunities.

The role emphasizes return-to-work facilitation, accurate documentation, and proactive settlement negotiations to align with state regulations and internal

Qualifications

• Bachelor’s degree in a related field.
• Three (3) years of experience in a workers’ compensation claims environment.
• Experience handling claims in multiple jurisdictions preferred.
• Bilingual skills preferred.

Responsibilities

• Verifies workers’ compensation coverage of employers and injured employees.
• Determines compensability under workers’ compensation by thorough investigation of the claim.
• Determines causal relationship between the reported injury and the incident to ensure appropriate payment of benefits.
• Facilitates return to work for the injured employee.
• Establishes timely and appropriate reserves based on the profile of the claim within given authority based on anticipated financial exposure.
• Documents specifics of claims with potential for subrogation recovery, including amount of potential recovery monies.
• Manages medical bills for non-indemnity and indemnity claims directly associated with the claimed injury.
• Concludes and closes files following resolution of claims to meet internal performance standards while complying with state legislation to avoid penalties and manage expenses.
• Negotiates settlements with attorneys or injured parties within given authority at the earliest possible point to bring cases to final disposition.
• Works closely with manager on complex files or files above settlement/reserve authority.
• Manages outside vendors to ensure cost containment efforts.
• Establishes and maintainseffective workingrelationships with all internal and externalcustomers.
• Stays abreast of changes in workers’ compensation statutes, case law and rehabilitation efforts/advancements in order to accurately interpret and apply relevant laws.
• Administers complex claims and catastrophic exposures within authority, including claims from dedicated large accounts.
• Exercises independent judgment to settle cases prior to mediation or litigation.
• Actively participates in agent/client relationship management.
• Assists in mentoring team members.

Job description

AF Group in South Carolina is seeking an intermediate level claim handler to manage workers’ compensation claims with a focus on moderate to difficult cases. You will investigate, determine compensability, and establish reserves within authority, while coordinating with managers on complex matters and potential subrogation opportunities.

The role emphasizes return-to-work facilitation, accurate documentation, and proactive settlement negotiations to align with state regulations and internal